Tuesday, December 30, 2008

During the last few weeks, our baby boy was slowly losing his battle with Diabetes & Cushing's. We made the hardest decision to let our baby go. He went to sleep for the last time while I was holding him at 12:55 am on December 28, 2008.

Saturday, December 6, 2008

I mentioned the other day that Hunter has been playing more. For the past few nights, after dinner, he gets one of his four stuffed toys and brings them to Vivian. She’ll be sitting on the sofa and he’ll put his toy up on the edge of the cushion. He wants her to flip the toy in the air. He used to play like this when he could see. Although, he usually would get tired out easily and would pant. We feel he probably had the beginnings of Cushings then. We’ve learned that besides the obsessive water drinking and eating, panting is also a sign of Cushings. Since he’s been regulated, he’s only panted once or twice.

It was so much fun watching him play. Apparently each toy has a different smell because he would pass the others by until he found the right one. Last night he played with his red bow and he found it each time. Vivian would praise him when he found it and brought it back to her. You could tell he was having a great time. He played for about 10 to 15 minutes, which was the longest we’ve seen him play in a long time. It was wonderful.

Wednesday, December 3, 2008

Hunter seems to be doing pretty well. We’ve noticed this past week that he’s been playing more and more with his stuffed pets. He’s even walking around with them, which we haven’t seen him do that since July. I do have one concern and that’s his hair loss. He got a bath yesterday and he lost a large amount of hair. In fact, he has lost more hair since being on Lysodren. I'll be making an appointment for him to get the second ACTH test on December 15th, at this time I'll ask about him losing so much hair.

Insulin Shots

First, I mark on the calendar when I puncture the insulin bottle. I count up 28 days and note that on the calendar. However, giving Hunter 21 units, twice a day, I use the bottle up before 28 days.

Before I give Hunter his shot, I take the insulin out 30-45 minutes before injection and let the insulin get close to room temperature. Remember, cold insulin hurts. Be sure to gently roll the insulin between your palms and don’t shake it. Letting the insulin get to room temp also helps in not having so many air bubbles. For me, it’s easier for me to completely fill the plunger and then tap the tube to make any air bubbles go to the top and then push them out. Sometimes, especially if it’s a new bottle, I won’t have to push all the insulin out of the tube and can then make the adjustment. There are a lot of times though where I get huge bubbles and just have to keep filling and emptying over and over. There have been some occasions where the plunger just isn’t working and I have to use a new syringe.

I mainly give Hunter his shots by myself. It’s a ritual now after he’s eaten and I’ve given him his Benadryl and L-thyroxine with cheese. I get the shot ready and then I call him over and put my arm around him and start to massage him. Once he consents (don’t force) and lays down I give him a short body rub and then proceed to pinch up his skin between his shoulders. Since he’s lost weight, it’s easier to pinch the skin up. You want to inject the needle in just below the skin. Push the needle in right below where your thumb and forefinger are holding the skin up. Our vet had said to push the needle in “between” your forefinger and thumb. Well, my daughter and I both had nicked our fingers with the needle and once I pushed the needle right through Hunter’s skin and when I pushed the plunger, insulin sprayed out onto the carpet! That’s not what you want. So that’s why I aim for right below the fingers.

When you inject the needle and start to push the plunger, I let go of the skin. Make sure that you have injected all the insulin before you remove the needle. There were two or three times in the beginning where I had pulled the needle out before all the insulin had been injected. If that happens, just let it and don’t try to re-inject more insulin. I then rub that area and then it’s time for the eye drops. I don’t let him get up and I position myself behind his head to give him his drops. It’s easier for me to give him a shot than to put drops in his eyes. If your dog is like Hunter and is a kicker, be sure those legs are away from you. Believe me, it’s easier to give eye drops when he’s lying down and his legs aren’t pointed towards me.

Friday, November 21, 2008

On November 19, we did a glucose curve on Hunter. He’s not the best patient to work with. I don’t blame him either. The choice we were given was to either get a blood sample from his ear or the bottom of his paws. I opted for the bottom of his paws.

If it wasn’t our drive to get Hunter well, I’m not sure I would have been able to give the shots and draw the blood. I’m a squeamish kind of person, especially about shots and veins. I’m getting warm just typing this…no kidding.

Hopefully, if you’re reading this and your pet has been diagnosed with diabetes, you’ll have an easier time in getting a blood sample. Hunter is a fighter, although when he was at his sickest, he didn’t fight that much. He’s feeling and acting more like normal, so he’s back to being a fighter. We have to use a muzzle on him. We lay him on his side, one person holds his front legs and another straddles him. I’m the one who straddles him to get the sample. We have everything set-up and ready; the meter with the strip, lancet, and cotton ball with alcohol.

Perhaps sticking his ear would get a better sample, but after viewing videos online, there’s no way I could do that. Unfortunately, I usually have to stick him a few times to get a good sample. It’s rare to get a good sample on one try.

This was his first glucose curve since he was on the Lysodren and here are the numbers. He get’s his first shot within five minutes of him finishing his breakfast, which is around 8:45. You take the first sample two hours after shot #1 and every two hours until 10:45 pm.

We were a bit concerned about the last number being at 205. So, yesterday, we took a sample at 10:45 am and it was 209 and again at 2:45 pm and it was at 184.

The doctor called me back yesterday afternoon and he was very pleased with his numbers! I was so surprised since to me it looked like he was all over the place. I was busy reading on the internet before he called for a “safe” range. It seems they vary; however, the doctor recommends anywhere between 60 and 180. He wasn’t too concerned that Hunter’s numbers did reach up in the 200’s, as long as they come down.

The time to be concerned is when he starts to drink more water and needs to urinate more. I’ve decided to keep the gallon jug, which I have marked off, to track his water usage. After seeing Hunter drink so much water these past few months, it’s hard to remember what was “normal” for him. I have the jug marked off to around 5 cups. The recipe is supposed to be 1 ounce of water for every pound. Hunter has gained back some weight, in the past 2 ½ weeks and I estimate him to be around 32-34 lbs. I also started to cut back on the food a little bit, to around 1 ¼ cups of food for each feeding. I’m still adding a little less than ¼ cup of scrambled eggs to his food, or he wouldn’t eat. We’ve basically stopped all treats, except for some doggie cookies I found online for diabetic dogs.

In about three weeks, I’ll make an appointment for another ACTH test. We were hoping that we would be able to cut back on his amount of insulin, but that’s not going to happen. When I was looking for the “safe range” for glucose numbers, I did read that dogs that have Cushing’s and diabetes, usually have to take more insulin. That seems to be holding true.

Monday, November 17, 2008

I took Hunter back to GVS on November 12 for the ACTH Stimulation Test. He again had to fast from the night before. This time he only stayed for two hours. I had noticed that there had been a drastic decrease from his drinking water on the 9th. I had a gallon jug and would fill it to the half gallon mark. Some days Hunter would drink a little over a half gallon of water.

The cost of this test was $160. I had sent a syringe of insulin, but since he wouldn’t eat, they didn’t give it to him. They took a glucose reading and it was in the 400’s, which was not so bad since the last time he had had his shot was at 8:30 the previous night.

We got the result of this test the next day and it showed Hunter was in the range where the doctor wanted him to be. I was very relieved since I’ve read where some dogs don’t respond to Lysodren. I was also concerned that we may have to do a second dosing.

Tomorrow, November 18, Hunter starts his maintenance dose. The doctor said he has seen better results in halfing the maintenance dose, instead of giving it all at once. Since Hunter’s dose is 1 ¼ pills, I will give him ¾ of a pill tomorrow and two days later, I’ll give him ½ a pill. After four weeks on his maintenance schedule I’ll take him back for another ACTH test to see if he’s still in the good range. On November 19th, we’ll take another glucose curve and see where his numbers are at. He’s still taking 21 units, twice a day. I’m hoping his numbers have improved.

I’ve noticed in the past few weeks that he’s getting around the house better and not running into walls too much. He’s walking more cautiously. I also started lightly yanking the leash up when we’re getting ready to step up onto the patio, which seems to help him a bit more. Because of finances, I’m not sure if we’ll be able to afford removing his cataracts. I was hoping we would be able to and I’m still trying to figure out a way that we can. We still haven’t sold anything at our online jewelry store, which would certainly help, but I’m still hopeful.

Sunday, November 9, 2008

Today marks day five that Hunter has been on Lysodren. He’s tolerated the pill so far and we haven’t seen any difference in his behavior.

I’m very anxious to get Hunter regulated. I read yesterday about a family whose dog just had diabetes. They finally got him regulated and in less than a year he stopped eating and became extremely depressed. In the end, they finally made the decision to put him to rest. I pray that I don’t have to make that decision.

Three years ago, we made the decision to let our cat, Tut, go. Tut was 14 ½ years old. He had stopped eating and drinking water. It was a very hard decision, but we didn’t want to see him suffer anymore. If the same was happening to Hunter, due to old age, I wouldn’t hesitate to let him go. However, Hunter is sick due to an illness and we feel we must do everything we can to help him get better. We’re all praying that we can get him back to feeling as close to normal as possible.

He’s still a fighter and we’re all here fighting right along with him.

Thursday, November 6, 2008

I mentioned that Hunter doesn’t play with his toys anymore. We noticed that when Hunter’s vision had a marked decrease, he became depressed for about three weeks. I believe he re-acted the same as any human would. For those few weeks, he was a little bit needier than he had been. At night, the girls and I watch a drama and he needs to lie in our laps and be rubbed. Even now, every night we do this ritual. He doesn’t like being picked-up too much, so we coax him to jump onto the sofa by himself.

I read on someone’s site that when their dog lost their sight, they would talk to them constantly. So we did. Even though Hunter belongs to everyone, I’m his alpha dog. It’s very important for him to know where I am all the time. That hasn’t changed. Everyone talks to him, especially when he's laying down and we're walking near him so he knows who's there. I also learned a lesson when I went to vacuum one day. I started to vacuum near him and it scared him so much he urinated. So now, I start the vacuum away from him so he won't be scared when I start to come near him. I also tell him he needs to move, which helps.

He had to re-learn the layout of downstairs. We put up a child gate to block him from going upstairs. He doesn’t do stairs very well. He’s bumped into the walls, but he’s gotten a lot better now. I also bought another child gate and put it up to keep him out of the kitchen while I’m doing the dishes. Even though he hears the dishwasher being opened, he still hit his head pretty hard on it.

That also brings me to his hearing. We believe he doesn’t hear as well as he had. Possibly, due to his age, his hearing had been going, but because he still could see we didn’t notice it. So if you have a geriatric dog, who loses his/her sight, you may notice they’re not hearing as well too.

One of the challenges has being taking him outside. I bought doggles (goggles for dogs/cats), but we haven’t tried them yet. One area to really work on is going outside. For a month now, I’ve used the command “stay.” I give him the command to “go” when the door is ready, but he always starts off too early. I keep him on a short leash when we go on/off the patio. I tell him “down” and “up” for when we’re getting on/off the patio. He’s been doing better this past week.

It’s very important to remember, you are their eyes and to be aware of all the obstacles outside; such as, branches, cars, the house. You have to watch them constantly, as I’ve taken my eyes off of him for a second and he hit the house. So, when we’re near objects, I keep him close.

We started Lysodren yesterday. I wore gloves to cut the pill, as I have to give Hunter 1 ¼ pills. I felt a little numb under my nose and I later got a tiny headache. I'm not sure if it was from the Lysodren or not, so this morning, I wore a mask and went outside to cut the pills.To get Hunter to eat, I always scramble some eggs and keep them in the refrigerator for a few days and mix the eggs with his food. I add about 1 ½ tablespoons to his food. I've read on other sites where owners have problems getting their dog's to eat. If you decide to do this, be sure you don't add any seasoning or butter/oil when cooking the eggs.I placed half of his food in his bowl and then gave him his pills. I used to give Hunter the pill pockets, but had to stop because they contain corn syrup. So, we went back to cheese. Just mold the cheese around the pill (still wearing gloves). I had a package of disposable gloves, I turn them inside out when taking off and throw away.He tolerated the pill well, as it can possibly make them throw-up. However, about 6 to 7 hours later, he got up and was walking very wobbly. On the pill bottle it says this is a side-effect, but that’s an effect for humans. I called the doctor to make sure. He wasn’t sure it was caused by the Lysodren or not. I also told him that Hunter has a cold. He has all these other problems and for him to catch a cold just wasn’t needed. So, the doctor said to give him half a pill in the morning and ¾ of pill at night. So far this morning, we’re doing ok.

The doctor told me that the one problem that may occur is when he’s been on these pills for about five days, his sugar levels may drop suddenly. Hunter is taking 21 units of insulin at this time, which to me is a lot. We will most likely have to adjust his insulin to a lower amount. Just in case his blood sugar goes too low, I have corn syrup ready.

Vivian took pictures of Hunter the other day and I’ve posted them. I don’t know if you can tell from the side view, but even though Hunter has lost a lot of weight, he still has an extended tummy, which is supposed to be typical of a dog with uncontrolled Cushing’s. You can also see the damage that was done to his coat from one flea.

Vivian also took a picture of his face. It’s easy to see how severe his cataracts are. You can’t tell from the picture, but the cataracts look like crystals. While she was taking his picture and using the flash, he appeared to detect the flash a little. Usually Hunter would bark and jump when he would see the camera flash. It’s bitter sweet that he doesn’t do that anymore, just like he doesn’t play with his stuffed animals anymore.

Tuesday, November 4, 2008

If only I could turn back time. I could rant forever about lost time. I will forever wonder if I compromised Hunter's health.

I worried about Hunter constantly. I feel I was caught-up in not knowing what to do and feeling completely lost. Caring for Hunter had been no different from when my mother had cancer. There was that same feeling of helplessness and you just listen to what the doctors say because you trust them.

Hunter started taking 8 units of insulin twice a day on July 8th. My daughter and I were shown how to administer his shots. I feel we have now perfected that, which I'll go through later.

I took Hunter back on July 24 for a blood fructose test. He was testing with higher numbers on his glucose test so they took blood for the fructose test. It's supposed to be a better gauge of how controlled or not the diabetes is. Hunter's test results came back that he was now regulated. Also, Hunter had lost 6 pounds since we had also changed his diet to Purina DCO food.

I did not notice any change in Hunter. He was still drinking a lot of water and having accidents inside the house. My mistake was not taking Hunter back during the month of August. Part of that was because it was sometimes hard to tell if he was improving or not. Some days he acted normal, and didn't drink a lot then he would be gorging himself on water.

I took Hunter back on September 6 and saw one of the owner's. I told him how much water Hunter was drinking and he suspected that Hunter's kidneys may be shutting down. So more blood work to test his kidneys and he increased his insulin to 11 units. At this time, we had noticed a big difference in Hunter's vision. He was bumping into things and the doctor said that was to be expected. Well, it was news to me as no one had told me he would lose his vision. Hunter's bloodwork came back a few days later and there was no sign of his kidneys shutting down.

I took Hunter back a little over a week later, and this time I saw the other owner. He increased Hunter's insulin to 12 units. In the next few days after increasing his insulin, I was afraid he was going to die. I would wake-up and check on him during the night. You could barely see him breathing. I took Hunter back on September 29th and finally saw the vet Hunter had mainly been seeing the last few years. She couldn't believe how Hunter looked. She was surprised that Hunter was now blind and how thin he was. I think it had to be fate, as the other two vets were not available and she was really concerned about Hunter. She referred Hunter to the Georgia Veterinary Specialists.

I hate to bring up money, but I feel it's important. When I tried to look-up how much a test would cost, like the Cushing's test for example, all I would find is "it's expensive." I found out it wasn't nearly as expensive as I initially thought. So, when I took Hunter for his annual exam to the end of September, we had spent close to $2,000 and Hunter was worse from when this all started. I was charged over $100 each time I took Hunter back. You feel after spending so much that you should have something to account for and all I had to account for was that Hunter looked worse, his diabetes was still uncontrolled and was now blind. On top of all that, I had three vets, with three different ideas on how to treat him. I don't know if Hunter's case had anything to do with this (I feel it does), but the vet Hunter has mainly seen quit the next week after she referred us to GVS.

On October 1, I got an appointment at GVS. Hunter's doctor is a godsend. He suspected that Hunter had Cushing's. He gave Hunter an ultrasound and checked his vital organs and so far Hunter's organs have not been affected by his uncontrolled diabetes.The cost for this exam was $920. It included the initial exam and consultation for cataract sugery. Ultrasound of his abdomen, a complete urinalysis, two glucometer tests and eye drops. Also included was the cost of the AlphaTRAK glucometer, lancets and test strips.As of today, I still hope that is holding true. However, he noticed that his adrenal gland was plump, indicating Cushing's. An opthamologist also check his eyes. Hunter's eyes were bulging and extremely inflammed. Due to his diabetes being uncontrolled, fluid has built-up in his eyes. The opthamologist checked him out, prescribed eye drops and said he was a very good candidate for cataracts removal. That is our goal for the beginning of next year.

The doctor wanted to control Hunter's diabetes before he tested him for Cushing's as sometimes you can get a false positive. One thing the doctor did was to suggest we buy the AlphaTRAK glucometer. I had asked our regular vet about this and was told no, they would do the testing. It is so much better and easier for us to do the testing. So, for the month of October we would test Hunter and call the doctor with the results. The doctor would call back and we would increase his insulin. Unlike our vet, we would only have to wait two days before we would do another gluco curve. We did a gluco curve on October 22, Hunter was then taking 19 units twice a day and his number were too high to register. His insulin was increased on October 23 to 21 units and the doctor felt that we needed to go ahead and do a Cushing's test. He had wanted to get his diabetes under control, but this apparently wasn't going to happen.

I did have to take Hunter back to our regular vet on October 10th because his eyes became worse. Seems he also had conjunctivitis. I was also told by this vet that he had seen the doctor's comments that Hunter possibly has Cushing's. Unbelievably, he still didn't feel Hunter has Cushing's. This is the same vet who believed Hunter's kidneys were shutting down.

On October 29th, Hunter spent 8 hours at GVS for the dexamethasone suppression test. He fasted the night before, so I sent along some food and his shot for insulin. As I expected, he didn't eat. The cost of this test was $205. The results came back the next day confirming that Hunter has Cushing's. The doctor said there were two options of treatment, one was Lysodren and the other a drug from England called "Vetoryl" or Trilostane. From what I had read about Trilostane, the FDA has not approved it for the treatment of pets with Cushing's. Trilostane blocks instead of eroding the layers of the adrenal gland. Once you stop taking Trilostane, the cortisol levels rise again. Also, Trilostane has fewer side-effects. The doctor recommened Lysodren, as he had had better results using this. So we went with Lysodren. The doctor called in Lysodren at Walmart. This pill can be extremely expensive. I have seen sites selling one pill for over $11. At Walmart the cost for 15 pills was $84.46 or roughly $5.63 per pill.

Tomorrow, November 5, I will start giving Hunter 1 ¼ pills for 7 days. Lysodren was originally given to human's for andrenal cancer. I've read that you need to take precautions while handling this medicine. I've read that you'll need to wear disposable gloves while cutting the pill and it's a good idea to use tweezers to pick the pills up and place on cheese.

Lysodren works by eroding away the layers of the adrenal gland to hopefully slow down the over-production of the cortisol hormone. This will be the initial "loading" phase. I'll first give Hunter some food, give him his pill wrapped in cheese and then let him finish eating. I'll be watching for lethargy, vomiting, diarrhea, loss of appetite and anything else. At the first sign of any of these symptoms, I'll call the doctor. You don't want too much of the adrenal gland destroyed. I'll also be looking out for any symptoms of too much insulin. There's a high possibility that he's taking too much. I have the corn syrup ready just in case.

Once Hunter is finished with the loading phase, I will take him back for an ACTH stimulation test to see where his cortisol levels are at. If his levels are back in the normal range, he'll be put on a pill once a week for maintenance and then after a few months he'll take another ACTH test.We're all hopefull that everything will go well.

Sunday, November 2, 2008

These pictures were taken of Hunter two years ago (2006), when he was 9-years-old. When I posted these pictures they made me cry. He looks so full of spirit and just absolutely beautiful. In just two short years he has changed. In the past few months, he has changed drastically.Hunter has survived a bout with cancer last August . He had a malignant carcinoma removed from his inner thigh. Thankfully, we had caught it in time. We had originally thought he had been bitten by an insect. It was a small red raised area. The surgery removed all the cancer and we felt we had nothing else to worry about.Also, off and on last year, Hunter was losing hair in clumps. We found that he had one flea. This one flea did a lot of damage to his coat. We had always used Frontline, but for some reason it wasn't working as well as it had in the past. He had an allergic reaction to the flea saliva, also known as flea allergy dermatitis or FAD. Hunter was on antibiotics for months and we washed him every week with a special shampoo called Malaseb. When his hair started to grow back, it grew back differently. His coat is no longer uniform. After we thought this was over and we started using other flea control products, he started to lose his hair again and again, we found one flea. This time he lost most of the hair on his tail and that has not grown back as of today. So he looks a bit scruffy. However, things didn't stop there.Last year he started to drink water, a lot. I took him to the vet and the new vet thought he might have Cushing's. However, this vet was overruled by the two vets who own the practice, and Hunter was never tested. Since I had known and trusted the other vets, I listened to them. His over drinking subsided and he was acting normal again, except for the fact that he panted a lot. We now know that panting is one of the symptoms of Cushing's.On July 3rd of this year, I took him for his annual check-up. At this time the regular blood work was done. Three to four years ago, Hunter had been diagnosed with hypothyroidism and had been taking L-thyroxine with no problems. He has always been a little bit heavier than we wanted him to be, however, he was by no means fat, as you can see from his pictures. His blood work results came back the next day and when the vet called me, I was shocked to learn he had canine diabetes (Diabetes Mellitus).

This is a blog about our family member Hunter. He's an 11-year-old Jack (Parson) Russell Terrier who has recently been diagnosed with both Canine Diabetes (Diabetes Mellitus) and Cushing's disease. Just having one of these diseases can be extremely devastating.